Cognitive adverse effects of new antiepileptic drugs

In the treatment of epilepsy adverse effects of medication must be recognized as being as important as seizure freedom. Cognitive deficits often occur in chronic epilepsy and may sometimes reflect adverse effects of antiepileptic drugs. However, the successful treatment of seizures frequently outweighs these adverse cognitive effects. Adverse cognitive effects of medication mostly concern certain cognitive domains, such as attention or executive functions but memory and language disturbances may also occur. Psychiatric comorbidity, e.g. depression has detrimental effects on cognition which should be considered when mood stabilizing drugs are withdrawn. With the exception of topiramate, most of the newer antiepileptic drugs seem to have a favorable profile of adverse effects on cognition; however, only few studies have directly compared cognition between newer and classic antiepileptic drug treatment. In the individual patient, standardized neuropsychological assessment may help to detect even subtle signs of cognitive decline and to improve the evaluation of the cause of (subjective) cognitive decline.